October 2019

Highlights from the 2019 ASCRS ASOA Combined Ophthalmic Symposium

Manjool Shah, MD

Naveen Rao, MD

Terry Kim, MD

Steve Charles, MD

Nicole Fram, MD

Sumit “Sam” Garg, MD

Keith Warren, MD

Mitchell Weikert, MD

Validating your biometry by ensuring that your data makes sense and ensuring your staff is trained in validation can help reduce refractive surprise, said Manjool Shah, MD, Ann Arbor, Michigan. Tools that can give you more information include ultrasound biomicroscopy, which is helpful for suspected or known zonulopathy cases; A-scan/B-scan for cases of poor optical view or optical biometry; specular microscopy for eyes with shallow anterior chamber depth, previous angle closure, or known endothelial disease; and macular OCT for patients seeking advanced technology IOLs.

Naveen Rao, MD, Peabody, Massachusetts, recommended physicians record themselves as they practice their informed consent speech. Try to get it under 1 minute without talking too fast. He also recommended splitting the cataract evaluation into two visits: a dilated visit for macular OCT and to introduce concepts, expectations, and provide informed consent documents, and a second undilated visit for topography, biometry, IOL options, and to sign informed consent.

In many cases, Terry Kim, MD, Durham, North Carolina, thinks LASIK/PRK are more accurate, safer, simpler, more accessible, and more sensitive options for addressing residual refractive error compared to IOL exchange. However, if you have more than 1.5 D of error, he recommended exchange.

“There is a tremendous amount of invisible pathology” that can be identified when looking at all gray-scale OCT B-scan slices, said Steve Charles, MD, Memphis, Tennessee, speaking on the importance of taking OCT on every cataract surgery patient to avoid visual surprises.
Nicole Fram, MD, Los Angeles, offered her top five pearls for managing poorly healing epithelial defects:
• Determine etiology; take a thorough history
• Look at the medications; change topical medications to preservative free
• Use amniotic membrane early in refractory disease
• Evaluate and treat abnormal eyelid anatomy and disease
• Know when a tarsorrhaphy is necessary and act quickly to avoid corneal thinning

Tips for using the miLOOP (Carl Zeiss Meditec) from Mitchell Weikert, MD, Houston:
• Stain the capsule and size the capsulorhexis appropriately
• Understand the mechanics of snare expansion/contraction
• Carefully pass the snare under the stained capsule
• Monitor instrument angle
• Maintain black ring at incision
• Use a second instrument to prevent lens tilt
• Anticipate delay of the snare with rotation and go beyond the midline
• Carefully break the nuclear bridge
• Rotate with a second instrument and fracture a second time